Provider Demographics
NPI:1245409911
Name:HUSSEY, JASON S (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:S
Last Name:HUSSEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 14TH AVE SE STE D
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3718
Mailing Address - Country:US
Mailing Address - Phone:253-200-2144
Mailing Address - Fax:253-200-2145
Practice Address - Street 1:120 14TH AVE SE STE D
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372
Practice Address - Country:US
Practice Address - Phone:253-200-2144
Practice Address - Fax:253-200-2145
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10005340363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant